Can peripheral venous pressure be interchangeable with central venous pressure in patients undergoing cardiac surgery?

OBJECTIVE: Pressure measurements at the level of the right atrium are commonly used in clinical anesthesia and the intensive care unit (ICU). There is growing interest in the use of peripheral venous sites for estimating central venous pressure (CVP). This study compared bias, precision, and covariance in simultaneous measurements of CVP and of peripheral venous pressure (PVP) in patients with various hemodynamic conditions.

DESIGN AND SETTING: Operating room and ICU of a tertiary care university-affiliated hospital.

PATIENTS: Nineteen elective cardiac surgery patients requiring cardiopulmonary bypass were studied.

INTERVENTIONS: A PVP catheter was placed in the antecubital vein and connected to the transducer of the pulmonary artery catheter with a T connector. Data were acquired at different times during cardiac surgery and in the ICU.

MEASUREMENTS AND RESULTS: A total of 188 measurements in 19 patients were obtained under various hemodynamic conditions which included before and after the introduction of mechanical ventilation, following the induction of anesthesia, fluid infusion, application of positive end expiratory pressure and administration of nitroglycerin. PVP and CVP values were correlated and were interchangeable, with a bias of the PVP between -0.72 and 0 mmHg compared to the CVP.

CONCLUSIONS: PVP monitoring can accurately estimate CVP under various conditions encountered in the operating room and in the ICU.